Background: Postoperative pain increases the incidence of venous thrombosis and respiratory complications, prevents early postoperative ambulation, and prolongs hospital stay. Fascial plane injections such as erector spinae plane (ESP) block and quadratus lumborum (QL) blocks are popular methods for postoperative pain control and reducing opioid consumption.
Objectives: We aimed to evaluate the analgesic effects of ultrasound-guided ESP versus QL block during laparoscopic cholecystectomy for the reduction of pain and analgesic consumption.
Study design: Prospective, double-blind, single-center, randomized controlled clinical trial.
Setting: Minia University Hospital, Minia Governorate, Egypt.
Methods: Patients scheduled for laparoscopic cholecystectomy from April 2019 through December 2019 were randomly allocated into 3 groups. After induction of general anesthesia, Group A received an ESP block, group B received a QL block, and group C didn't receive any block (control). The main outcome was the time to the first analgesic request. Secondary outcomes were the pain intensity measured by the Visual Analog Scale at one, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively at rest and cough. The total analgesic requirement during the first 24 postoperative hours, hemodynamics, and any complications were recorded.
Results: Sixty patients scheduled for elective laparoscopic cholecystectomy were enrolled; the clinical and demographic data were similar in the 3 groups. Groups A and B had lower VAS scores at cough than Group C in the first postoperative 2 hours. Compared to Group C, a higher score was reported at 8, 12, and 16 hours in Group A, and at 8 and 16 hours in Group B. Group B had a higher score at 4 hours than Group A. At rest, Group C showed higher scores than Groups A and B in the first 2 hours, while higher scores were noted at 16 hours in Group A and 12 hours in Group B. Time to first request of analgesia was significantly prolonged in Group A than in Groups B and C (P < 0.001). Our study showed that Groups A and B had lower postoperative analgesic requirements than Group C (P < 0.05).
Limitations: This study had a small number of patients enrolled.
Conclusions: Both ESP and QL blocks effectively reduced VAS scores at both cough and rest. There was a decreased total consumption of analgesics in the first postoperative 24 hours with a longer duration of analgesia, which lasted 16 hours in the ESP group and 12 hours in the QL group.
Keywords: cholecystectomy; postoperative pain; regional analgesia; Plane nerve block.